- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.53 / $3,105.00 / $8,738.67
| Facility | | $1,365.53 | $3,105.00 | $8,738.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,272.00
| Facility | | $2,430.00 | $5,486.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,339.85 / $19,913.50 / $26,542.00
| Facility | | $3,339.85 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |